Catalyst Newsletters Archive - Page 15 of 18 - Mental Health Commission of Canada

Stephanie Knaak

In conversation with structural stigma researcher Dr. Stephanie Knaak

Stephanie Knaak has been studying structural stigma for the better part of a decade. She’s an expert in the foundational policies, laws, and practices in our health-care system that put people who live with mental illness at a disadvantage.

“But that doesn’t mean I have all the answers,” said Knaak from her home office in Golden, B.C., where she’s been working since the onset of the pandemic. “Sometimes I get overwhelmed. It’s a beast of a challenge to tackle because some people can’t see structural stigma, and others are suffocating under its weight. It all depends on where you’re sitting.”

When asked how something so invisible to some and dead obvious to others can be addressed, she paused. “In health-care settings, if you aren’t measuring it, it just doesn’t matter. We’ve got to show providers and administrators the true cost of these blind spots by giving them tools that can bring them to light. Then, we’ve got to use the evidence of those gaps to make a case to close them.”

New frontiers
Knaak and her colleagues at the Mental Health Commission of Canada (MHCC) are charting new territory. For example, they are mapping out the topography that people living with mental illness must face when seeking basic physical health care.

“A person’s mental health may have nothing to do with the reason for their visit, but it becomes a huge barrier to getting timely and proper diagnosis and treatment — because physical complaints are often dismissed or seen only through the lens of their mental health diagnosis. The system doesn’t have the right checks and balances to make sure these kinds of blind spots get caught,” she explained. “This is the equivalent of a mountain, and we’ve got to identify it on a map so we can point to it and say, ‘How are we going to scale this?’”

Unlike the early explorers who were blind to their own limitations, Knaak approaches this new body of research with the humility born of experience.

“We’re finding out new things every day. This area of study is massive. It’s almost intimidating to put a stake in the ground, because its constantly shifting beneath you. But someone has to be first. Someone has to say, “OK, we have to get better because people are bearing the consequences of system inertia. We’ve got to get the wheels in motion. Even if we have to backtrack and start again, we’ve got to get moving.”

If you build it . . . they will come (around)
Knaak believes that by forcing policy change in health-care settings a different attitude will follow. “Take handwashing, for example. Because it has standards for when, where, and how to do it, hospitals measure it so they don’t fall outside the protocols. If we want things to change for people living with mental illness, we need to write protocols that explicitly name and address the behaviours that are manifested by structural stigma.”

“In a way, it’s easier to change the mind of one individual,” said Knaak, who has worked to develop many of the MHCC’s Opening Minds anti-stigma training programs. “But what excites me is the ripple effect when you’re doing work to change the entire culture of care. It has the capacity to improve the experience of every person who walks through the door.”

Putting a stake in the ground
Up next for Knaak and the structural stigma team is creating the tools to help organizations plot a course toward improved care. This could include structural stigma report cards, client satisfaction surveys, and other measurement tools.

“It’s all in the service of identifying the barriers and pitfalls that can create such dispiriting and damaging experiences for people when they are vulnerable and at their place of greatest need,” said Knaak. “Essentially, we’re asking people who are working hard within a flawed system to unlearn what they’ve been conditioned to believe and to be open to doing things differently — not only as professionals, but as people.”

Knaak is referring to the way stigma is so imprinted on the DNA of organizations — as well as our own. “It’s like stigma at the cellular level, literally. It’s thrumming below the surface all the time, and it can erupt at any moment with disastrous results.”

When the professional becomes personal
Knaak is familiar with what that looks like. She has watched a loved one try to get help from a system that is not designed to effectively address the needs of a person living with mental illness.

“It’s ironic that my work came home to roost. All the things I was documenting as a researcher were laid bare. I had data points and key informant interviews and hundred-page reports. They all said the system was broken. But when you experience it up close, how it sometimes impedes the healing process more than it helps it along. . . . For me, this work has now become more personal, and more imperative, than ever before.”

When asked what success looks like, Knaak’s answer is surprisingly simple. “I often hear my family members who’ve experienced cancer laud the system for the timely, effective, compassionate care they received. All I want is the same thing when someone experiences mental illness.”

“Surely,” she said, “that’s not too much to ask?”

This is the third in a three-part series on structural stigma. Previously we talked to a care provider and a service user.

Author: Suzanne Westover

Suzanne Westover

An Ottawa writer and former speechwriter, and Manager of Communications at the Mental Health Commission of Canada. A homebody who always has her nose in a book, she bakes a mean lemon loaf (some would call her a one-dish wonder) and enjoys watching movies with her husband and 13-year-old daughter. Suzanne’s time with the MHCC cemented her interest in mental health, and she remains a life-long learner on the subject.

MHCC launches virtual course — delivered by first responders, for first responders

Pauline Meunier

For Pauline Meunier, a paramedic of 26 years, it took a trip to the allergist to give her anxiety a name.

“What I thought were allergic reactions turned out to be panic attacks,” she said. “Before I was asked about anxiety, it never occurred to me that my mental health could be the problem.”

That difficulty in recognizing one’s own mental injury or illness, she explained, is common among first responders, as is the undertone of stigma or self-stigma that may prevent someone from seeking help.

Now, as a training and delivery specialist with the Mental Health Commission of Canada’s (MHCC’s) Working Mind team, and a facilitator for the new The Working Mind – First Responders (TWMFR) Virtual course, Meunier is helping to break the cycle.

“First responders know that taking care of their physical health is critical to performing at their best,” she said. “Through this training, we want them to understand that caring for their mental health is equally important.”

The freshly revamped course is now being delivered virtually (until it becomes safe again to do so in person). Using an evidence-based approach, it gives first responders the knowledge they need to self-assess and also to talk about mental health — including strategies to help them cope with challenges and resources to seek out when they need support. To maximize the material’s resonance, its scenarios and terminology are tailored to each relevant group (e.g., paramedics, firefighters, police), and the course’s facilitators all come from first responder backgrounds.

A mental health pulse check
For those who work in the helping professions, especially in the extreme situations faced by first responders, it can be easier to recognize distress in someone else than in oneself. But the course’s mental health continuum model offers a way to help them do so. It matches a range of thoughts, attitudes, and behaviours to a colour-coded mental health spectrum: green (healthy), yellow (reacting), orange (injured), and red (ill).

For Meunier, that continuum — in the form of a wallet card — led to her own personal breakthrough.

“While attending a presentation, I was staring at the miniature mental health continuum on my table when it struck me — I was deep into the orange and I needed help,” she said. “As paramedics, we aren’t good at putting ourselves first. But as I learned first-hand, the continuum can be an effective tool for all first responders to check in with themselves and recognize when they need extra support.”

Leveraging language
One new component in the updated course is an emphasis on language. Based in part on the MHCC’s Language Matters guide, participants learn the value of using person-first language (where appropriate) as a powerful way to reduce stigma around mental illness and substance use.

Based on research showing that labels like “crazy” or “addict” can perpetuate stigma and discourage help seeking, participants are encouraged to use language that paints a more accurate picture by putting the human first and the condition second; for example, “this person is living with a mental illness or an addiction.”

“In the field, it’s easy to rely on labels as a sort of shorthand for easier communication,” Meunier explained. “But if we make an effort to use respectful language, we can help overcome stigma rather than contribute to it.”

The way forward
While there is still a long way to go in reducing stigma and establishing parity between mental and physical health among first responders, Meunier is hopeful for the future.

“If there’s one group who cares about excelling at their jobs, it’s first responders,” she said, adding that with the help of courses like TWMFR Virtual, the idea that mental wellness is part of that success is gaining traction.

“The most rewarding thing about facilitating these courses is receiving messages from participants who say things like, “it all makes sense now” or “this explains so much.” Those moments of realization can be life changing — I know it was for me.”

To learn more about the benefits of TWMFR Virtual for your organization, contact solutions@openingminds.org

Author: Amber St. Louis

Amber St. Louis

New MHCC resource aims to support women sidelined from the workforce

Even before the onset of COVID-19, statistics told a story of a persistent unequal division of labour, with women shouldering more unpaid housework and caregiving responsibilities than men.

As quarantine measures began, the toll on women only deepened — both at home and at work. One recent study found that mothers were more than twice as likely as fathers to be worried that their work performance was being judged negatively because of caregiving responsibilities.

“The statistics are stark — yet not surprising if we look at the context,” said Louise Bradley, the Mental Health Commission of Canada’s (MHCC’s) president and CEO. “Not only am I concerned about losing — literally overnight — the hard-won progress toward equality that was gained over decades, I am also worried about the mental wellness of women who are being asked to make an impossible choice.”

According to a recent national survey, one-third of working women have thought about quitting their jobs because they are juggling home-schooling, homemaking, parenting, and professional responsibilities.

For those who do leave their jobs, re-entering the workforce can lead to a fruitless game of catch-up.

A new resource
When it’s time to go back into the working world, women are confronted with emotional and practical challenges that their male counterparts rarely have to consider. To assist employers who wish to support women employees in making a strong return to the workforce — while keeping mental health front and centre — the MHCC has created a new resource.

The recommendations emphasize the importance of things like flexibility, workload management, and empathy, regardless of the reason for needing time off.

“Few workplace resources account for the unique challenges faced by women, and that’s a problem,” said Tiana Field-Ridley, an MHCC implementation specialist on the Workplace

“My mother is contemplating a return to work after spending her prime earning years supporting her elderly parents. It just illustrates that women may need support making the transition in and out of the workforce more than once in their lives. Our minds may turn to gaps associated with maternity leave, but we’ve got to broaden our thinking to span a woman’s entire professional life.”

In addition to supporting women’s mental wellness through the transition back to work, the new resource encourages employers to be aware of implicit biases that may be limiting their hiring pool and work to strengthen policies so they uplift women.

“We’ve got to re-educate employers about gaps on resumes, for example,” said Liz Horvath, manager of the Workplace Mental Health team. “A gap shouldn’t automatically be interpreted as an alarm bell. It might have also been an opportunity for that person to explore and gain new skills while tending to someone else’s needs. Caring for a sick relative can lead to incredible growth in a person’s compassion or organizational skills.”

As Horvath points out, being able to reframe a woman’s expertise following an absence has great value, especially when you consider that 62 per cent of the jobs lost between February and March of 2020 were held by women.

“Many of the jobs in schools, child-care centres, hotels, restaurants, and shops were gendered roles. But that in no way diminishes the skills required to pull them off,” she said.

Start with transparency
For employers, welcoming women back to work can also include postings for new jobs.

“Attracting great female candidates can be greatly enhanced by transparency in job postings, which could include anything from being vocal about diversity to enthusiastically promoting flexibility,” said Horvath. “That could also translate into offering on-the-job training, in recognition of the fact that women will often take themselves out of a race before it has even begun.”

“I’ve seen this throughout my entire career,” added Bradley. “That adage about a woman seeing a job posting and choosing not to apply because she only has 80 per cent of the qualifications, whereas a man may throw his hat in the ring even if he’s got significantly less, is trite because it’s true. So, as organizations we’ve got a responsibility to be as inclusive as possible lest we alienate great contributors.”

Above all, said Field-Ridley, the best way any of us can support a woman who is returning to the workforce is to build her up. “It takes a lot of confidence to return to work after an absence,” she said. “With the right approach, employers can create a supportive environment for women to flourish and meet their full potential.”

Author: Amber St. Louis

Amber St. Louis

New community-based research explores cannabis consumption during pregnancy and parenthood

Late last year, the Mental Health Commission of Canada (MHCC) announced its funding of 14 community-based research projects to explore cannabis use in priority populations. All the initiatives address important and often overlooked groups in research, including youth, immigrant, refugee, ethnocultural, racialized, and Indigenous populations. One such group is pregnant individuals and parents, the focus of a unique research project based in Ontario.

A fresh perspective
“To date, research about cannabis consumption during pregnancy and parenthood has been clinical in nature, emphasizing cannabis as a ‘risk’ and its association with ‘substance abuse,’” said lead researcher Allyson Ion. “Our team is taking a different approach by focusing on the experiential knowledge of pregnant individuals and parents. As people who consume cannabis, they are at the heart of the issue.”

In addition to people with living experience, the research includes providers in perinatal care and child welfare, along with other health- and social-care leaders who can share first-hand insights into the kinds of tools that may be needed to strengthen direct care practices and policies.

For Krista Benes, director of the MHCC’s Mental Health and Substance Use team, this inclusive approach is at the core of what sets community-based research apart. “The lens of first-hand experience is invaluable,” she said. “If we really want to understand the relationship between cannabis consumption and pregnancy and parenting, who better to involve than the individuals who live those realities every day?”

Expanding the conversation
Despite cannabis being the most commonly consumed substance during pregnancy, the stigma surrounding its consumption is pervasive. That stigma, the researchers fear, may hamper opportunities for honest and helpful conversations in health- and social-care spaces and create barriers for individuals seeking out information and support.

“Many pregnant people and parents continue to experience surveillance around their cannabis consumption because of broader notions about what it means to be a ‘good’ parent,” said team member Saara Greene. Yet current research on the effects of cannabis consumption during the perinatal period is ambiguous, and health-care guidelines and practices are largely based on laboratory research using animal models and controlled clinical studies.

While the research team acknowledges that cannabis may not always be “harm-free,” they say more research is needed to determine the relationship between cannabis consumption and perinatal and parenting outcomes — as told by the parents themselves.

“There is a significant lack of research looking into the intentions and desired effects of cannabis consumption during the perinatal period and while parenting,” said team member Kelly Pridding. “We believe that more holistic, participatory, and community-based research approaches will go a long way toward dispelling myths and misconceptions and expand this important conversation.”

A knowledge-to-action framework
The initial phase of the research involves a series of dialogue-based sessions exploring different experiences and perspectives among the stakeholders on the intersections of cannabis, pregnancy, parenting, and mental health. Using a knowledge-to-action framework, researchers will then turn the feedback from those conversations into practical tools and recommendations.

“The most exciting thing about this work is the potential to create real-world practice and policy applications,” said Ion. “Our goal is to develop concrete tools, practice approaches, and/or policies that can be applied in perinatal care and child welfare practice settings, ultimately strengthening the quality of care and reducing cannabis stigmatization in the process.”

As Benes sees it, this project represents an important new chapter in cannabis research. “We still have a long way to go in closing the knowledge gap between mental health and cannabis consumption in priority populations,” she said. “But every time we include those populations in the work that is ultimately meant to serve them, we make that gap a little bit smaller.”

With special thanks to research team members Allyson Ion, Saara Greene, Theresa Kozak, Gabrielle Griffith, Kelly Pridding, Claudette Cardinal, and Gary Dumbrill (in collaboration with the McMaster Health Forum). Team members wanted to specifically express their gratitude for MHCC funding and also acknowledge the financial support received from the Social Sciences and Humanities Research Council and the Canadian Centre on Substance Use and Addiction.

Author: Amber St. Louis

Amber St. Louis

Samaria Nancy Cardinal and the cost of neglecting recovery

Samaria Nancy Cardinal learned two important lessons at her father’s knee: the power of persistence and the importance of mustering courage in the face of oppression.

Those lessons have served her well on a long and winding journey to recovery from mental illness. When asked about how she became a patient advocate, she paused, burdened by the weight of her response.

“I lost 15 to 20 years of my life because of misdiagnosis and ineffective treatment,” she said from her home in Calgary, where she will graduate with a diploma in social work this spring. “I was labelled bipolar, and when that happens it may as well be tattooed right on your forehead. Within the system, you cease to be a person and are defined solely by your illness.”

For Cardinal, separating one’s humanity from one’s disease is anathema to her Indigenous heritage.

“We see people for all of what they are — their physical, emotional, mental, and spiritual selves are inextricably linked. You can’t understand why someone is experiencing symptoms like mine if you simply tick boxes from a medical manual. You’ve got to be willing to dig a little deeper, to ask ‘why’?”

A failure to appreciate
But, as Cardinal pointed out, that digging takes time, and our health-care system is built to prioritize the speed of diagnosis, rather than the value of achieving recovery. She says it’s one of the many ways the very structure of care needs to change.

As the daughter of Douglas Cardinal, the first Indigenous architect in Canada, the metaphor she teased out is no surprise.

If a house is riddled with toxic mould, she said, you wouldn’t slap pretty yellow paint on the walls and call the problem sorted. To make that house safe and livable you need to rip out the rot and rebuild it from the studs.

In the same way, she argued, the health-care system’s twin crises of unconscious bias and discrimination need to be named and remedied — with no time to waste.

“My father couldn’t get his degree in Canada because of racism. It’s true that he didn’t let discrimination crush his dreams. He went on to study at the University of Texas in Austin and became one of this country’s most celebrated names in the field,” Cardinal said, pointing to achievements like the Canadian Museum of History. “But his talent only underscores the potential we’re wasting if we’re pushing people down rather than lifting them up.”

Finding the exit
She understands first-hand how people can spend years on a quest for mental health support, living a half-life in the shadow of an illness, unable to claim their rightful place as contributing members of society.

“I can never get back the time I lost,” said Cardinal, who became emotional as she reflected on all that was taken from her. “But what I can do is try to be part of rebuilding a system that puts recovery at its centre.”

Helping others has become her own North Star as she strives to advocate for a system where symptoms are not evaluated without examining their root causes. It was this motivation that led Cardinal to be part of the Mental Health Commission of Canada’s efforts to dismantle the barriers to care created by structural stigma.

“For the record, my bipolar diagnosis wasn’t accurate,” said Cardinal. “I was pumped full of medication, with the dose ramped up time and again because it wasn’t working. Can you imagine treating someone for cancer, discovering their tumour is continuing to grow, and the medical team refusing to change protocols? There would be a hue and cry.”

But for years, there was no such outrage for Cardinal.

She walked a seemingly endless, dark, lonely tunnel without any sign of an exit. The light finally appeared when her symptoms were correctly diagnosed as post-traumatic stress disorder, and she was finally able to access the tools needed to tame her trauma.

Seeing and hearing others
Despite her own experience, or perhaps because of it, Samaria is determined to be the light for others.

“You can’t imagine how desperate you can feel when no one will listen, when no one will believe you, when you’re dismissed and disregarded time and time again.”

Cardinal now plans to pursue an advanced degree in social work, and her agenda is a simple one.

“When I see someone sit down across from me, I will see the person first. Period. I will give them what I was denied: recognition of their humanity. And in that small way, I will be working to rebuild something that’s broken.”

Author: Suzanne Westover

Suzanne Westover

Ambitious 10-year strategic plan aims at transformational change in Canada’s mental health landscape

For Chuck Bruce, board chair of the Mental Health Commission of Canada (MHCC), the need to invest in mental health isn’t a question — it’s an imperative.

“I’ve worked with tangible investments my whole career,” said Bruce from his home office in Newfoundland and Labrador, where he runs the province’s largest public sector pension fund. “I typically see a return in terms of dollars and cents — but you can’t put a price on mental wellness.”

That’s why Bruce, together with the MHCC’s board of directors, set out to draft a blueprint that could help renovate a mental health system with dangerous gaps and cracks still running through its foundation.

Building on past successes
“Answering the Call isn’t prescriptive,” he said, referring to the MHCC’s freshly released 10-year strategic plan. “It’s a bold, ambitious vision to uplift the voices of lived experience, enhance co-operation across our many partnerships, and dig into those areas that have been overlooked far too long. We cannot afford to stall the progress on mental health promotion, mental illness prevention, and supports and treatments just as we are hitting our stride as an organization.”

The new plan is supported by three pillars: Inquire, Inspire, and Improve. For Bruce, “they are the lifeblood of what we do at the MHCC: We open minds by seeking out the best research and disseminating it. We open hearts by combating stigma in all its forms — including structural barriers (that are as invisible as they are dangerous). And we open doors with improved access to services through cutting edge demonstration projects.”

The right frame for growth
“As a board, our job isn’t to tell the experts who make up the MHCC’s leadership and staff how to go about creating this change. For the same reason, I wouldn’t tell a builder where I wanted load-bearing walls or how to engineer my bathroom. Instead, I might say, I want an open concept home with lots of light.”

In the new plan, the MHCC’s board has left plenty of room for the creativity, responsiveness, and entrepreneurship that have been a hallmark of the organization’s first decade.

“When I first became acquainted with the MHCC, on their workplace advisory committee, my knowledge of the organization’s footprint was reasonably narrow,” said Bruce. “Many years later, I’ve come to realize that, while we’re a relatively small group, we’re spotting and plugging holes at every turn. From community-based suicide prevention to creating mentally healthier university and college campuses or delivering resiliency and anti-stigma training, we make use of every last funding dime to create the kind of society that reflects our shared ideals — recovery chief among them.”

The road ahead
When asked what success might look like for the 10-year plan, Bruce paused. “I don’t want to predict where this plan will lead us because I believe in the power of compound knowledge.”

The idea is built on the investment principle that dollars increase over time through the strength of compound growth. “It’s the most powerful tool we have to create wealth,” he said. “And reinvesting in the knowledge we gain is the most powerful means to create transformational change.”

For Bruce, that change is within our grasp — and always has been.

“When my mother was diagnosed with breast cancer 25 years ago, my father didn’t want it discussed. It was family business, and it was private. Period.”

On reflection, Bruce suspects that shame played a role in his father’s perception of breast cancer. “And he wasn’t alone in that. But over the years, we’ve seen the Run for the Cure gain momentum and grow, we’ve seen the CN Tower light up pink, we’ve seen speciality appliances and lipsticks with a portion of proceeds going to breast cancer research. And the implicit message in all of this is that there is no shame. I’d say it has worked for many health issues, but we aren’t there yet when it comes to mental illness.”

Measuring progress
If the MHCC’s strategic plan is successful, Bruce said, there will be similar markers along the way.

“We’ve got to celebrate the victories. The e-mental health interventions that hurdle geographic barriers. The standards that are changing how we study and work. The Mental Health First Aid program that’s trained more than 500,000 people in Canada (and counting). Each of these is narrowing a gap or filling a crack. Building a solid foundation.”

And until that work is done, Bruce is convinced that by reinvesting our knowledge to open minds, hearts, and doors, there will be a marked net profit.

“I’m a numbers guy, after all,” he conceded. “We’ll be measuring our returns and reporting on progress to our key investors — and that’s every single person living in this country. Because mental health . . . matters to all of us.”

Author: Suzanne Westover

Suzanne Westover

COVID may steepen the climb for those affected by eating disorders

Content Warning: This article contains information about thoughts and behaviours related to eating disorders.

The first week of February marks Eating Disorders Awareness Week, a national public awareness campaign dedicated to shedding light on the reality of eating disorders (EDs) and the people they affect. Before COVID-19, EDs had one of the highest mortality rates of any mental illness. Now, with routines upended and isolation at its peak, the journey toward wellness is even more arduous for some.

“When you live with an eating disorder, free time is a dangerous thing,” said Wendy Preskow, president and founder the National Initiative for Eating Disorders (NIED). “In the absence of many pre-pandemic outlets and routines, the voices encouraging ED behaviours only become louder.”

Preskow isn’t just speaking from her nine years of experience running NIED. She is also a full-time caregiver to her daughter Amy, who has struggled with eating disorders for over 20 years.

“With so many of Amy’s prior activities and distractions taken away, I can feel the tension of her free time,” said Preskow. “I have to keep her company just to help her get through the day. When you’re in that state, every second counts.”

A perfect storm
For the one million or so people in Canada diagnosed with an ED — and the countless others suffering in silence — the empty space in the day is just one of the challenges during a pandemic.

Increased anxiety, uncertainty, and a perceived lack of control can all encourage ED behaviours (i.e., restricting, binging, purging, or overexercising) — which are often used as coping mechanisms in times of stress. Add to that the advent of “the quarantine 15” (the potential weight gain associated with the pandemic), and it’s not hard to understand why crisis lines and services for EDs and have had a marked influx since the arrival of COVID-19.

A strained system
Unfortunately, as Preskow pointed out, these services were already stretched to their limit prior to the pandemic. Now, the situation is dire. “Many outpatient programs have had to completely shut down, and others have seen their wait-lists double or triple,” she said. “So many people need support, but they can’t find it.”

In some cases, the search for help includes parents seeking treatment for young children, who are increasingly engaging in dieting behaviours that may heighten their risk of developing an ED.

As a recent Globe and Mail article noted, “Children as young as 9 and 10 are being treated for eating disorders. Pediatricians say many of their new patients are sicker and more underweight than those typically seen before the pandemic, while the wait time for outpatient referrals has doubled to six months.”

or Preskow, these trends are not acceptable. “When you’re seeking help for a loved one with an ED, waiting doesn’t feel like an option.”

The challenges of caregiving
In the early days of Amy’s illness, Preskow recalls how each filled-up program, unavailable service, or unanswered query felt like a devasting blow to her and her husband.

While NIED isn’t a service provider, she has still channelled that experience into her daily work. “When someone reaches out, I do my best to follow up right away,” she said. “I remember how it felt to be absolutely desperate for guidance. I wouldn’t wish that on anyone.”

To this day, Preskow said, being a caregiver is a constant challenge. And after 20 years, she’s still overcome with fear when she sees Amy calling. “I’ve asked her to text me a heart before she calls so that I know everything is OK. Then I can answer without panicking.”

For other caregivers struggling to navigate their loved one’s illness, Preskow urges unconditional love above all else. “We have to remember that having an eating disorder isn’t a choice. It can be hard not to take setbacks personally, but that person needs love and encouragement, no matter what.”

The road to wellness
While COVID-19 has ushered in a new wave of challenges for those affected by EDs, support is still available. NIED’s list of resources includes options for immediate support, interactive tools, and a variety of other programs. The National Eating Disorder Education Centre (NEDIC) also offers many helpful resources, including a helpline and a list of COVID-19-related information, events, and support.

As for Amy’s journey, after two long decades, she’s managed to find a new footing. “Right now she’s climbing the tallest mountain in the world,” said Preskow. “There’s still a long way to go, but it’s worth every step.”

Author: Amber St. Louis

Amber St. Louis

In conversation with Dr. Thomas Ungar, the first in a series

When Thomas Ungar, psychiatrist-in-chief at St. Michael’s Hospital and associate professor at the University of Toronto, was asked to describe the structural stigma that spells poorer health outcomes for people living with mental illness and substance use disorders, he responded in a most unusual way.

“Perhaps I should tell you about the silly garbage cans,” he said from his office in Toronto, where he engages in a daily campaign to help his peers and colleagues in other specialties better understand the complex nature of mental illness.

A hospital where he once worked brought in some “efficiency people” to tighten the budget. At one point, they determined that garbage receptacles in clinical spaces would be emptied daily while those in “administrative” or “non-clinical spaces” would only be done every two weeks.

“I don’t see patients in rooms with sinks,” Ungar explained. “And the litmus test for “clinical space” by the powers that be was, you guessed it, whether or not it had a sink.”

For Ungar, the implicit bias was clear. For “real” medicine, you need to wash your hands. Psychiatric work — the lowest paid specialization in medicine — didn’t make the cut.

Medical versus mental health care needs
Such an example may sound insignificant, but Ungar has dozens, if not hundreds like it. In fact, he collects these small indignities like unwanted mementos. They serve as a constant reminder that providing mental health care remains the poor cousin of practising in the purely physical realm.

Taken as a whole, they add up to an immeasurable inequity.

“There was the time when I went to a meeting to get some equipment I needed for my department,” he recalled. That included new locks, because some doors on his floor had been kicked in, and improved video monitor safety equipment. But these seemingly straightforward requests were quickly brushed aside. “I was told to talk to facility management or IT because, again, my needs weren’t ‘real’ medical needs.”

“And,” added Ungar, “we’re always being left behind. When a hospital moves to a brighter, newer space, the psychiatry department is invariably told we’ll be joining ‘soon.’ Then ‘soon’ becomes months, and in some cases years. We’re left behind in crumbling, run-down buildings because we’re told having a dedicated space for mental health care is better for the patient. Who are we kidding? It’s just more palatable for everyone else.”

The effects of mental health care inequity
Yet Ungar’s greatest frustration isn’t that his speciality is sidelined. It’s that people suffer as a result.

“When you present to the emergency room, regardless of your mental health history, you should be given an appropriate physical workup. Only in psychiatry would the treating physician refer someone to you directly, without doing such a rudimentary exam. Imagine an ER doctor taking one look at you and saying, ‘Right, I think it’s your heart, off to cardiology you go.’”

This cavalier, and all-too-prevalent, attitude can have dire consequences. Ungar himself is familiar with cases where patients have died of blatant neglect because of “diagnostic over-shadowing.”

“It’s when an assumption is made that physical complaints are not relevant or reliable because someone has an underlying mental illness or substance use disorder,” he explained, “and it’s not acceptable.”

Dealing with structural stigma
Ungar finds himself swimming against the tide in a profession where stigma is so entrenched, and unconscious bias so pervasive, that most of the well-meaning professionals practising within it are totally unaware of its existence.

“It’s not unlike racism,” he explained. “You don’t have to throw around epithets or be blatantly discriminatory to uphold implicitly racist societal norms. Being unaware of something doesn’t make you a bad person, but it doesn’t make you part of the solution either. The same is true for stigma. Just because you don’t use pejorative terms doesn’t mean you aren’t unconsciously dismissing a patient as ‘badly behaved’ or ‘morally corrupt’ because they are presenting in a way that’s uncomfortable or inappropriate.”

While the beauty of not knowing is that it can be fixed, a complete paradigm shift is a generational proposition, and Ungar doesn’t have that kind of time.

“It doesn’t mean I’m not trying,” he laughed, but he also thinks additional strategies are needed. “I’m leveraging quality of care as a central tenet of why we need to address structural stigma,” he said, noting that building certain patient safeguards into hospital policy may be the quickest route to fulfilling the Hippocratic Oath.

A new way forward
“For it to count, we need to measure it,” Ungar noted, “and not just in egregious situations that trigger a coroner’s inquest.” Here, he recounted an instance where a patient died of a pulmonary embolism because concerns about his mental health overshadowed the physical discomfort he was experiencing.

Ungar wants to change the rules of the game, full stop. He wants hospitals to assess structural stigma against qualifiers that effectively dismantle it. “For example, if we require all patients to receive a physical exam within one day of being admitted, suddenly it doesn’t matter whether Dr. Smith thinks it’s necessary. It’s simply required.”

This kind of intervention is what Ungar refers to as a health-care system “hack”: a quick and imperfect shortcut to improve results, while the longer-term work to shift attitudes and behaviours plods along in the background.

To help health-care administrations understand, evaluate, and score structural stigma against a framework that breaks down the barriers putting treating mental illness at a disadvantage, Ungar is working with a team at the Mental Health Commission of Canada (MHCC) to create tools and new standards.

Describing this project, he said, “If we can measure and monitor those barriers and get them on a mandatory dashboard or at-a-glance report card, then a red-light indicator will scream out for attention and require a fix. I won’t have to try and advocate, negotiate, or convince others one provider at a time. I’ve had it with that.”

In fact, Ungar sees this path as a decisive way forward. “The work I’m doing with the MHCC is the most exciting of my professional career. I’m not aware of this kind of work being done anywhere else. It’s the kind of progressive, thoughtful policy shift we’ll look back on in two decades and say, ‘I can’t believe we didn’t do that sooner.’ Our current practices will seem as outmoded to our future selves as bloodletting does to us now.”

Until then, Ungar plans to continue using his considerable influence to call out stigma wherever he finds it.

“Of course I will,” he said with a laugh, “even if that means telling stories about silly garbage cans.”

Webinar
Register here for the first webinar on the MHCC’s work to combat mental illness- and substance use- related structural stigma in health care settings — to be held Tuesday, February 9, 12-1:30 p.m. ET — featuring professors Thomas Ungar, Heather Stuart, Jamie Livingston, Javeed Sukhera, and Stephanie Knaak. Participants will increase their understanding of structural stigma, learn about its sources and consequences, and gain insights into how it can be addressed.

Watch this space
In the March Catalyst we’ll be speaking with patient advocate Samaria Nancy Cardinal about the harmful effects of structural stigma users are experiencing in the health-care system.

Author: Suzanne Westover

Suzanne Westover

MHCC winter mini-guide aims to give workplaces seasonal boost

In Canada, most people are all-too-familiar with the physical challenges of working through the winter. From dressing to driving, the importance of changing the way we operate to protect ourselves from the cold goes without question. It’s too bad we rarely give our mental wellness the same consideration.

This winter, because mental strain in the workplace may be especially pronounced, employers should be equipped to support themselves and their staff members.

A new workplace resource
The Mental Health Commission of Canada’s (MHCC’s) new Mini-Guide to Help Employees’ Mental Health Through Winter offers employers a roadmap to wellness during the chilly season.

“Many leaders recognize that this time of year can be hard on employees. But the tools and resources out there are piecemeal,” said Liz Horvath, manager of Workplace Mental Health at the MHCC. “To help employers spend less time searching for solutions and more time applying them, we’ve gathered a wide range of practical advice and helpful resources in one place.”

The mini-guide lays the groundwork for its recommendations by exploring some of the most common reasons for mood changes in the winter months. For some it’s the lack of sunlight, for others it’s poorer eating habits or reduced physical activity. Whichever factors are at play, it’s their cumulative effect that can make it more difficult for employees to feel focused, engaged, and productive — both inside and outside the workplace.

A season of cold and COVID
This year may be especially difficult for those who experience a lower mood in winter. Some challenges are unique to the pandemic, like nostalgia about life before COVID, while others may be amplified versions of familiar concerns.

“Employees may face increased social isolation, financial strain, or uncertainty about the future — which are all linked to poorer mental health outcomes,” Horvath explained. “Before the pandemic, mental health conditions accounted for around 30 per cent of disability claims. But with the added burden of COVID-19, putting mental wellness at the centre of workplace culture is even more critical.”

Focus on flexibility
One key theme throughout the mini-guide’s recommendations is flexibility, which, as Horvath emphasized, needs to be tailored to effectively reduce stress. “It’s important for employers to engage with staff to define what flexibility means for each person,” she said, adding that even in fields with more limited options employers can still take steps to ensure that staff have adequate time to rest and are offered leniency when possible.

The guide offers several suggestions to help employers be more flexible, from allowing workers to modify their hours and focusing on output to identifying key priorities and letting the extras slide when they need some relief. Whatever form flexibility takes, the goal is to promote equilibrium for employees, which will in turn reduce undue stress.

“If we’re running out of energy, we can’t continue to produce at the same level,” said Horvath. “Flexible working arrangements can go a long way in helping employees create balance in their lives and improve their mental well-being at work and at home.”

Guidance for every season
While the guide is presented through a winter lens, its recommendations and resources apply year-round. Suggestions to help employers communicate with empathy, offer the right type of support, and help build coping strategies will continue to serve them long after the ground thaws.

Horvath couldn’t agree more. “By taking steps to foster more supportive workplaces today, employers will help themselves create a healthier, more resilient workforce for the future.”

With the right guidance, there’s no reason for any employee to leave their mental health out in the cold.

Author: Amber St. Louis

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